CommercialAdministrativeMedium impact
Point32Health Payment Policy updates
Harvard Pilgrim Health Care·Oral & Maxillofacial Surgery, Physical Therapy, Occupational Therapy +4 more·Reimbursement
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Point32Health is consolidating multiple payment policies across Harvard Pilgrim and Tufts Health Plan products into integrated Point32Health policies, affecting oral surgery, modifiers, therapy services, assisted reproductive technology, and home infusion. Sleep studies policies are being archived and redirected to clinical guidelines.
Action Required
By December 1, 2025: Billing team must access the Point32Health provider website Payment Policies section to review all updated integrated policies for oral surgery, modifiers, physical/occupational/speech therapy, assisted reproductive technology, and home infusion. For sleep studies, redirect to Evolent Clinical Guidelines for Harvard Pilgrim Commercial and EviCore Clinical Guidelines for Tufts products. Update billing software references from old Harvard Pilgrim and Tufts individual policies to new Point32Health integrated policies.